| NPI | 1912988841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TN DC-001053) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WV 528) |
| 111N00000X Chiropractor (Licence: PA DC-003771-L) | |
| 111N00000X Chiropractor (Licence: AL 1878) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2023-05-05 |