| NPI | 1386214724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 7.002232) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: CT 7.002232) |
| Enumeration Date | 2021-06-28 |
| Last Update Date | 2021-08-16 |