| NPI | 1669577649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000284) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC005113L) |
| 111N00000X Chiropractor (Licence: NJ 38MC00397900) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2007-07-08 |