| NPI | 1215063813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CA DC32022) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00387500) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2021-06-28 |