| NPI | 1780201970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008222) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9092) |
| Enumeration Date | 2020-07-03 |
| Last Update Date | 2022-02-03 |