| NPI | 1386042448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor Radiology (Licence: NY 012609) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012609) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2019-05-06 |