| NPI | 1356704688 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 002033) |
| Enumeration Date | 2016-04-04 |
| Last Update Date | 2019-03-20 |