| NPI | 1467804609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012806) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32396) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2016-07-12 |