| NPI | 1881983047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 4256) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: CO 4256) |
| Enumeration Date | 2011-03-28 |
| Last Update Date | 2011-03-28 |