| NPI | 1598257214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR007537) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00477800) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2018-05-30 |