| NPI | 1811446461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10011060) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x012870) |
| Enumeration Date | 2016-09-23 |
| Last Update Date | 2022-08-14 |