| NPI | 1245822758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X01371701) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007444) |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2023-12-07 |