| NPI | 1871691998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 1454) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007548) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2018-03-17 |