| NPI | 1831310416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008665) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00399800) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2011-08-22 |