| NPI | 1487186995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013024) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 33811) |
| 111NR0400X Chiropractor Rehabilitation (Licence: CA 33811) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2020-07-06 |