| NPI | 1518926039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0003489) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 3489) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2022-07-14 |