| NPI | 1225586852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X004892-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00265100) |
| 111N00000X Chiropractor (Licence: GA CHIR002031) | |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2016-09-12 |