| NPI | 1588947360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ID CHIA-1478) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013596-01) |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2023-06-09 |