| NPI | 1619319969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008391) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10953) |
| 111N00000X Chiropractor (Licence: NM 2085) | |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2025-11-12 |