| NPI | 1972970648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 11787) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012691) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2020-06-16 |