| NPI | 1982870267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6191) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26723) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-11-24 |