| NPI | 1801204730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0008455) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2013039642) |
| 111N00000X Chiropractor (Licence: KY 5464) | |
| 111N00000X Chiropractor (Licence: CO CHR.0008455) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-10-20 |