| NPI | 1285114090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013798) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00807700) |
| 111N00000X Chiropractor (Licence: WA CH60877942) | |
| 111N00000X Chiropractor (Licence: PA DC011492) | |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2025-02-24 |