| NPI | 1225241169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 010318) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 579962) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2021-08-20 |