| NPI | 1538402094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5196) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012326) |
| 111N00000X Chiropractor (Licence: VA 0104557043) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2022-12-15 |