| NPI | 1871123950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008245) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KS 01-06022) |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2022-06-02 |