| NPI | 1912297516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IA 007077) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010548, AJ010340) |
| 111N00000X Chiropractor (Licence: NY 011699-1) | |
| 111N00000X Chiropractor (Licence: IL 038011972) | |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2012-03-18 |