| NPI | 1457595605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011750) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 31457) |
| 111N00000X Chiropractor (Licence: NJ 38MC00737400) | |
| Enumeration Date | 2009-04-30 |
| Last Update Date | 2017-01-31 |