| NPI | 1982015889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 5152) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005233-1) |
| Enumeration Date | 2014-05-13 |
| Last Update Date | 2015-12-07 |