| NPI | 1174912125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012626) |
| Enumeration Date | 2015-01-14 |
| Last Update Date | 2020-09-24 |