| NPI | 1679606297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007299) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH8469) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2024-03-13 |