| NPI | 1861928145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA 34234) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007606) |
| 111NR0400X (Licence: CO EL.2786658) | |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2018-10-25 |