| NPI | 1386970945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007251) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011826) |
| 111N00000X Chiropractor (Licence: MD S03653) | |
| Enumeration Date | 2009-11-02 |
| Last Update Date | 2018-05-15 |