| NPI | 1164573382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 6768) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X006768) |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2024-02-28 |