| NPI | 1730436791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000897) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 8370668-1202) |
| 111N00000X Chiropractor (Licence: PA DC010890) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2024-04-04 |