| NPI | 1285331371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013696-01) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013696) |
| Enumeration Date | 2023-02-09 |
| Last Update Date | 2023-02-21 |