| NPI | 1316939580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3744) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004209-1) |
| 111N00000X Chiropractor (Licence: FL CH11269) | |
| 111N00000X Chiropractor (Licence: NJ 38MC00284600) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2024-01-26 |