NPI | 1447456629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00597000) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9354) |
111NS0005X Chiropractor, Sports Physician (Licence: FL CH 9354) | |
Enumeration Date | 2007-06-25 |
Last Update Date | 2018-10-27 |