| NPI | 1962562116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 6694) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7222) |
| 111N00000X Chiropractor (Licence: CA DC29637) | |
| 111N00000X Chiropractor (Licence: MA 1321) | |
| 111N00000X Chiropractor (Licence: CT 000694) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-09-26 |