| NPI | 1285356303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013639-01) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 002267) |
| Enumeration Date | 2022-09-15 |
| Last Update Date | 2026-06-04 |