| NPI | 1811291545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X08461) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: HI DC221) |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2011-01-10 |