| NPI | 1861694457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005453) |
| 111N00000X Chiropractor (Licence: SC 3104) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2019-06-30 |