| NPI | 1770717829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3671) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA dc009175) |
| 111N00000X Chiropractor (Licence: NY x011425-1) | |
| Enumeration Date | 2009-05-04 |
| Last Update Date | 2018-06-23 |