| NPI | 1720448368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NH NH963) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY NY012155) |
| Enumeration Date | 2016-02-24 |
| Last Update Date | 2016-02-24 |