| NPI | 1417354382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013068-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD S03819) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2018-11-21 |