| NPI | 1265898662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 38MC00788700) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 002908) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: NY 25mt00209700) | |
| Enumeration Date | 2016-01-14 |
| Last Update Date | 2025-10-03 |