| NPI | 1851562953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR008499) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00627100) |
| 111N00000X Chiropractor (Licence: NY 010972) | |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2018-12-21 |