| NPI | 1508866617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: KY 4278) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC04424) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2010-12-09 |