| NPI | 1205949716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00222600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC002389L) |
| 111N00000X Chiropractor (Licence: NC 1339) | |
| 111N00000X Chiropractor (Licence: VA 0104000361) | |
| 111N00000X Chiropractor (Licence: MA 230989) | |
| 111N00000X Chiropractor (Licence: NY X003079-1) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-10-12 |