| NPI | 1851342992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001461) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2225) |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2007-07-09 |