| NPI | 1225208093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AK 449) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3836) |
| 111N00000X Chiropractor (Licence: SC 3326) | |
| 111N00000X Chiropractor (Licence: NY 011205) | |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2019-06-24 |