| NPI | 1760682934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO .0007435) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA dc-30584) |
| Enumeration Date | 2007-07-24 |
| Last Update Date | 2016-06-28 |