| NPI | 1801909312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 20040002496) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-07-06 |