| NPI | 1043309503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NM DC2213) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7632) |
| 111N00000X Chiropractor (Licence: NJ 38MC00728300) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2019-08-28 |