| NPI | 1356483143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011221-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 3483) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-01-27 |