| NPI | 1225204738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013228) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AL 2244) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2019-06-26 |