| NPI | 1710355086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 33978) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007350) |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2017-11-03 |