| NPI | 1922335066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012232) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008517) |
| 111NS0005X Chiropractor, Sports Physician (Licence: OH 4080) | |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2015-08-12 |