| NPI | 1942390935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007283) |
| 111N00000X Chiropractor (Licence: GA CHIR008056) | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2020-02-29 |