| NPI | 1174807200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012858) |
| Enumeration Date | 2011-10-07 |
| Last Update Date | 2017-02-27 |