| NPI | 1912128471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00659900) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: IL 038-010717) |
| 111NS0005X Chiropractor, Sports Physician (Licence: IA 06861) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY 011408) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: CT 001720) | |
| 111N00000X Chiropractor (Licence: NY X-011408-1) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2015-03-04 |