| NPI | 1114223328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03727) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556982) |
| 111N00000X Chiropractor (Licence: NY 4444) | |
| Enumeration Date | 2011-02-04 |
| Last Update Date | 2019-09-05 |