| NPI | 1053353979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3134) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X-008982) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2019-11-07 |