| NPI | 1548568629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR0007032) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31942) |
| Enumeration Date | 2011-03-14 |
| Last Update Date | 2022-07-21 |