| NPI | 1811207749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: CO 7271) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012063-1) |
| Enumeration Date | 2010-10-13 |
| Last Update Date | 2019-06-11 |