| NPI | 1033715883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9107) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013401) |
| Enumeration Date | 2020-12-08 |
| Last Update Date | 2021-10-29 |