| NPI | 1639400591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3721) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011804-1) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2023-08-29 |