| NPI | 1902970676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000295) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: CT 000295) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2007-07-08 |