| NPI | 1811095391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 1691) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001691) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-09-03 |