| NPI | 1619266137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03728) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011997-1) |
| Enumeration Date | 2011-04-05 |
| Last Update Date | 2013-01-08 |