| NPI | 1720229941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6202) |
| Additional Taxonomies | 111NP0017X Chiropractor Pediatric Chiropractor (Licence: CO 6202) |
| Enumeration Date | 2009-03-18 |
| Last Update Date | 2011-08-06 |