| NPI | 1679947725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 0008379) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 080497) |
| Enumeration Date | 2015-11-29 |
| Last Update Date | 2023-05-23 |