| NPI | 1326080763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY XX0111741) |
| 111N00000X Chiropractor (Licence: HI 1071) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2024-06-19 |