| NPI | 1437812781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 007776) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC011843) |
| Enumeration Date | 2021-10-14 |
| Last Update Date | 2023-09-15 |