| NPI | 1932762929 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008562) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6604) |
| Enumeration Date | 2019-04-16 |
| Last Update Date | 2022-10-06 |