| NPI | 1083945000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010784) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00507600) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2023-02-16 |