| NPI | 1700924370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 1536) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY XO10706-1) |
| Enumeration Date | 2007-02-03 |
| Last Update Date | 2023-02-13 |