| NPI | 1972395309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008923) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IA 128955) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-05-21 |