| NPI | 1104386838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012759) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 70-012759) |
| Enumeration Date | 2019-03-20 |
| Last Update Date | 2025-04-02 |