| NPI | 1043311178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD 01504) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x005364-1) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2023-08-28 |