| NPI | 1275682155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013165) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33091) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2020-07-01 |