| NPI | 1558617787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3989) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010627) |
| 111N00000X Chiropractor (Licence: CT 1951) | |
| Enumeration Date | 2012-07-25 |
| Last Update Date | 2022-09-07 |