| NPI | 1770684821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 3384) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010294) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2018-04-09 |