| NPI | 1578883161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 4853) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: NY 0000) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2022-12-11 |