| NPI | 1912047366 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: GA CHIR010275) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00324200) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2021-08-02 |