| NPI | 1336877273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013638) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NY 013638) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY 013638) | |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY 013638) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: NY 013638) | |
| 111NN1001X Chiropractor, Nutrition (Licence: NY 013638) | |
| Enumeration Date | 2022-08-09 |
| Last Update Date | 2026-02-05 |