| NPI | 1669585691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 476) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL ch4616) |
| 111N00000X Chiropractor (Licence: NY X003820-1) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2011-10-09 |