| NPI | 1457419574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: FL CH 6555) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA 2629) |
| 111N00000X Chiropractor (Licence: NJ 38MC00651300) | |
| 111N00000X Chiropractor (Licence: MI 2301006555) | |
| 111N00000X Chiropractor (Licence: AL 1127) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-25 |