| NPI | 1801837851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000687) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC05538) |
| 111N00000X Chiropractor (Licence: PA DC007803L) | |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2022-04-15 |