| NPI | 1518207448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DC CH30132) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012255-1) |
| 111N00000X Chiropractor (Licence: MD S03863) | |
| Enumeration Date | 2013-03-01 |
| Last Update Date | 2018-03-23 |