| NPI | 1154794717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013889) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31269) |
| Enumeration Date | 2015-11-04 |
| Last Update Date | 2025-06-16 |