| NPI | 1255725099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012612) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 005534) |
| Enumeration Date | 2015-03-18 |
| Last Update Date | 2015-05-19 |