| NPI | 1720536956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007488) |
| Additional Taxonomies | 111NR0400X (Licence: CO EL.2786559) |
| Enumeration Date | 2016-09-16 |
| Last Update Date | 2016-09-16 |