| NPI | 1932386927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011525) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR008311) |
| 111N00000X Chiropractor (Licence: NJ 38MC00668000) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2008-12-03 |