| NPI | 1124543616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 002135) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012997) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2022-10-28 |