| NPI | 1568893501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AL 2829) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007995) |
| Enumeration Date | 2013-12-02 |
| Last Update Date | 2024-09-26 |