| NPI | 1831210459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 3647) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: CO 3647) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2009-05-22 |