| NPI | 1609430719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2146) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013532) |
| Enumeration Date | 2019-04-24 |
| Last Update Date | 2021-11-10 |