| NPI | 1295269306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4886) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012912) |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2018-03-23 |