| NPI | 1487852778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007345) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC 05384) |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2007-07-09 |