| NPI | 1780708461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.00007356) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR005181) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2022-03-04 |