| NPI | 1780060251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR0007288) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: CO EL2786426) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |