| NPI | 1093507279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2363) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: CT 3010) |
| Enumeration Date | 2025-05-21 |
| Last Update Date | 2025-10-31 |