| NPI | 1043901382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013806) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2282) |
| Enumeration Date | 2023-05-17 |
| Last Update Date | 2024-06-11 |