| NPI | 1548523111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007596) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR-6882) |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2013-02-19 |