| NPI | 1831115666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 10053) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA CH 2276) |
| 111N00000X Chiropractor (Licence: NY X009109-1) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2007-07-08 |