| NPI | 1396212098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013153-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X01353-1) |
| Enumeration Date | 2018-10-31 |
| Last Update Date | 2018-10-31 |