| NPI | 1609845114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY xoo6740) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X006740-1) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2017-09-21 |