| NPI | 1902061732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: CO 3981) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: CO 3981) |
| 111NR0400X (Licence: CO 3981) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 3981) | |
| Enumeration Date | 2008-07-21 |
| Last Update Date | 2008-07-21 |