| NPI | 1740707157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NC 5408) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY x012879-1) |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2023-09-29 |