| NPI | 1639154941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X007953) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104556324) |
| 111N00000X Chiropractor (Licence: NC 3382) | |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2024-12-13 |