| NPI | 1942422126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F1-0000786) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001342) |
| 111N00000X Chiropractor (Licence: MD 02183) | |
| 111N00000X Chiropractor (Licence: FL CH10142) | |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2018-09-21 |