| NPI | 1396783635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001677) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011213-1) |
| 111NN1001X Chiropractor Nutrition (Licence: CT 001677) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2010-04-20 |