| NPI | 1396708368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001517) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CT 001517) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2020-02-26 |