| NPI | 1811217581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012053-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010464) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2019-06-24 |