| NPI | 1649488339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CO 5112) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO 5112) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CO 5112) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-05-12 |