| NPI | 1508356486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2147) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4940) |
| Enumeration Date | 2018-05-16 |
| Last Update Date | 2021-03-18 |