| NPI | 1720155120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10747) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00646800) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-02-25 |