| NPI | 1568497436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008552-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006-0001009) |
| 111N00000X Chiropractor (Licence: NH 510-1197) | |
| 111N00000X Chiropractor (Licence: IA IA-006984) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2016-03-04 |