| NPI | 1962433268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC-28615) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007654) |
| 111NR0400X (Licence: CO CHR.0007654) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR0007654) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO CHR.0007654) | |
| 225000000X Orthotic Fitter | |
| 225100000X Physical Therapist (Licence: CO CHR.0007654) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2022-10-11 |