| NPI | 1548632334 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007358) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO EL.2786457) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2024-10-16 |