| NPI | 1548658974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007229) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2023-10-03 |