| NPI | 1700933926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO CHR.0008110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00608500) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2021-04-27 |