| NPI | 1770037673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NV B01877) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00736700) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2023-10-30 |