| NPI | 1518407469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 002000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012817) |
| Enumeration Date | 2017-02-26 |
| Last Update Date | 2021-04-26 |