| NPI | 1144299835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012393) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009543) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2018-12-04 |