| NPI | 1679830335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012666) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 32273) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2016-03-03 |