| NPI | 1902983885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011091-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00173800) |
| 111N00000X Chiropractor (Licence: CA 12151) | |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2010-10-05 |