| NPI | 1871670521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CO 4715) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CO 4715) |
| 111NR0200X Chiropractor, Radiology (Licence: CO 4715) | |
| 111NR0400X (Licence: CO 4715) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-12-23 |