| NPI | 1689003071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MD S03815) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012410) |
| Enumeration Date | 2013-11-06 |
| Last Update Date | 2017-04-28 |