| NPI | 1982748505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008850) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10279) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2025-08-21 |