| NPI | 1942528450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001822) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1822) |
| Enumeration Date | 2010-05-07 |
| Last Update Date | 2025-01-02 |