| NPI | 1982773495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 2329) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CO 2329) |
| 111NS0005X Chiropractor, Sports Physician (Licence: CO 2329) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2010-07-20 |