| NPI | 1235358193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008141-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR006449) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2018-01-03 |