| NPI | 1609834605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S01626) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH6753) |
| 111N00000X Chiropractor (Licence: HI DC654) | |
| 111N00000X Chiropractor (Licence: CA DC22789) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2010-07-12 |