| NPI | 1750737938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 7078) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-05553) |
| Enumeration Date | 2016-05-06 |
| Last Update Date | 2019-08-27 |