| NPI | 1740722255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0007529) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO EL.2786595) |
| Enumeration Date | 2016-11-15 |
| Last Update Date | 2022-04-22 |