| NPI | 1811290521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008909) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00688000) |
| Enumeration Date | 2010-12-20 |
| Last Update Date | 2019-06-10 |