| NPI | 1194585448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013825) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY x013825) |
| Enumeration Date | 2024-03-21 |
| Last Update Date | 2025-04-06 |