| NPI | 1104961549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000714) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: CT 000714) |
| 111NX0100X Chiropractor, Occupational Health (Licence: CT 000714) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-11-29 |