| NPI | 1942840756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9118) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013341) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2023-06-29 |