| NPI | 1770888232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6562) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: CO PTA.0013124) |
| Enumeration Date | 2011-01-14 |
| Last Update Date | 2014-02-05 |