| NPI | 1962825513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2263) |
| Additional Taxonomies | 174400000X Specialist (Licence: CT 006856) |
| Enumeration Date | 2014-01-31 |
| Last Update Date | 2022-08-24 |