| NPI | 1073651725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor Neurology (Licence: VA 0104000858) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: DE F--0000526) |
| 111NN0400X Chiropractor Neurology (Licence: NJ 38MC00446700) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |