| NPI | 1053891770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR009731) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00742800) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |