| NPI | 1376551515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01869) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7623) |
| 111N00000X Chiropractor (Licence: NJ MC05163) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2012-01-27 |