| NPI | 1093980286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3688) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010213) |
| Enumeration Date | 2008-04-28 |
| Last Update Date | 2024-09-12 |