| NPI | 1679957716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NE 1945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007320) |
| Enumeration Date | 2015-07-18 |
| Last Update Date | 2021-09-10 |