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 |