| NPI | 1942294913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 7026) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 4757) |
| 111N00000X Chiropractor (Licence: DE F10000388) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2008-10-29 |