| NPI | 1891812152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006163) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 000872) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2020-05-12 |