| NPI | 1578642138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x011979) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 18970) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2019-10-09 |