| NPI | 1639468630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009348-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10467) |
| Enumeration Date | 2011-03-31 |
| Last Update Date | 2021-08-20 |