| NPI | 1962662460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC011203) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00698700) |
| 111N00000X Chiropractor (Licence: NY X-011660-1) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2018-03-17 |