| NPI | 1336457993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC010283) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 4650-012) |
| 111N00000X Chiropractor (Licence: MN 5424) | |
| 111N00000X Chiropractor (Licence: MI 2301 009712) | |
| 111NN0400X Chiropractor, Neurology (Licence: OH 4113) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2017-09-19 |