NPI | 1194223057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CT 001066) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2185) |
Enumeration Date | 2018-01-25 |
Last Update Date | 2021-03-09 |