| NPI | 1770632127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000862) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: CT 000862) |
| 225700000X Massage Therapist (Licence: CT 000862) | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |