| NPI | 1326657354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X004359-1) |
| Enumeration Date | 2020-07-27 |
| Last Update Date | 2021-04-21 |