| NPI | 1073903324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70012650) |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2017-06-28 |