| NPI | 1205986700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 13878) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010394) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2024-11-12 |