| NPI | 1003018292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: CT 627) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 000627) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2019-05-07 |