| NPI | 1215076484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012371) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH007217) |
| 111N00000X Chiropractor (Licence: TX TX10818) | |
| 111N00000X Chiropractor (Licence: IL 038.011271) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2025-05-23 |