| NPI | 1821025156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: CT 867) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: CT 867) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2024-01-09 |