| NPI | 1053431965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 006650) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 8425) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2024-07-18 |