| NPI | 1154620037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: CT 001879) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001879) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2023-11-16 |