| NPI | 1669736245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: ND 972) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012189-1) |
| Enumeration Date | 2012-06-28 |
| Last Update Date | 2014-06-22 |