| NPI | 1316288376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012302-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CO CHR.0007931) |
| 111N00000X Chiropractor (Licence: VA 0104557071) | |
| Enumeration Date | 2013-03-14 |
| Last Update Date | 2020-12-18 |