| NPI | 1124410691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: CT 00-1997) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1997) |
| Enumeration Date | 2015-02-20 |
| Last Update Date | 2021-11-17 |