| NPI | 1629511738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007747) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 11939) |
| Enumeration Date | 2016-11-21 |
| Last Update Date | 2017-12-21 |