| NPI | 1376619197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NC 3403) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY X009097) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2015-08-05 |