| NPI | 1609918184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000546) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH0005022) |
| 111N00000X Chiropractor (Licence: NY X4250) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2007-07-08 |