| NPI | 1376679449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR001689) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH3044) |
| 111N00000X Chiropractor (Licence: MI 2301006749) | |
| 111N00000X Chiropractor (Licence: AZ 03525) | |
| 111N00000X Chiropractor (Licence: CO 3931) | |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2019-07-03 |