| NPI | 1548497506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x010828) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 547) |
| 111N00000X Chiropractor (Licence: VA 0104000248) | |
| 111N00000X Chiropractor (Licence: PA 003767-R) | |
| Enumeration Date | 2009-06-17 |
| Last Update Date | 2011-02-06 |