| NPI | 1083093066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4768) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70012661) |
| Enumeration Date | 2015-05-24 |
| Last Update Date | 2018-03-14 |