| NPI | 1649327784 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: WI 4227-012) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY #X009619) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2017-04-04 |