| NPI | 1710517065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 4619) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X013339-01) |
| Enumeration Date | 2020-01-24 |
| Last Update Date | 2021-01-14 |