| NPI | 1396167698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 1895) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3358) |
| Enumeration Date | 2014-01-06 |
| Last Update Date | 2014-01-06 |