| NPI | 1194175331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012849) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: NY 012849) |
| 111NR0400X Chiropractor Rehabilitation (Licence: NY 012849) | |
| Enumeration Date | 2016-06-19 |
| Last Update Date | 2024-02-27 |