| NPI | 1457403354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4436) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x0098261) |
| 111N00000X Chiropractor (Licence: PA DC007773L) | |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2015-01-01 |