| NPI | 1518498187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 8624) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013079) |
| Enumeration Date | 2017-03-24 |
| Last Update Date | 2018-04-26 |