| NPI | 1720044936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 10659) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH11101) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-04-12 |