| NPI | 1699941534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6485) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2008011447) |
| Enumeration Date | 2008-04-30 |
| Last Update Date | 2010-11-08 |