| NPI | 1952719965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: CT 001975) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1975) |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2023-02-28 |