| NPI | 1831461078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor Neurology (Licence: CT 0001901) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: CT 0001901) |
| 111NR0400X Chiropractor Rehabilitation (Licence: CT 0001901) | |
| Enumeration Date | 2012-02-03 |
| Last Update Date | 2012-02-03 |