| NPI | 1073647970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: DC CH030139) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 03576) |
| 111N00000X Chiropractor (Licence: NJ 38MC00656800) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: NY X011361-1) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: VA 0104556869) | |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-05-18 |