| NPI | 1184754665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01247) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH12103) |
| 111N00000X Chiropractor (Licence: NJ 38MC00601900) | |
| 171100000X Acupuncturist (Licence: NJ 25MZ00012300) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2019-07-18 |