| NPI | 1811362387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012760) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: NY 012760) |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2017-02-23 |