| NPI | 1194021790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3368) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010544) |
| 111N00000X Chiropractor (Licence: NY X012137-1) | |
| Enumeration Date | 2011-01-31 |
| Last Update Date | 2019-01-22 |