| NPI | 1861817249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR0007779) |
| Additional Taxonomies | 163WM1400X Registered Nurse, Nurse Massage Therapist (NMT) (Licence: CO 1619157) |
| 172M00000X Mechanotherapist (Licence: CO 0015634) | |
| Enumeration Date | 2014-02-21 |
| Last Update Date | 2018-06-22 |