| NPI | 1639406127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR-6429) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CO CHR-6429) |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2010-11-05 |