| NPI | 1366859761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012540) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012540-1) |
| Enumeration Date | 2014-07-17 |
| Last Update Date | 2019-08-20 |