| NPI | 1629326905 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6888) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: CO 6888) |
| Enumeration Date | 2012-08-17 |
| Last Update Date | 2018-04-11 |