| NPI | 1316322282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5727) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32888) |
| 111N00000X Chiropractor (Licence: NJ 38MC00710400) | |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2024-04-13 |