| NPI | 1629448196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013251) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 13045) |
| Enumeration Date | 2015-09-28 |
| Last Update Date | 2019-06-26 |