| NPI | 1417132713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA 009981) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011599) |
| 111N00000X Chiropractor (Licence: NY 011521) | |
| Enumeration Date | 2008-01-04 |
| Last Update Date | 2019-08-01 |