| NPI | 1588656599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 1138) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 10353) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2007-11-06 |