| NPI | 1003219189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x012572-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012572) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2020-05-07 |