| NPI | 1891857231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001507) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1507) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2008-10-02 |