| NPI | 1588936801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6774) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2011037863) |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2012-02-01 |