| NPI | 1174974976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2038) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 002038) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2025-09-25 |