| NPI | 1396874616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 010883) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 010883) |
| Enumeration Date | 2007-03-04 |
| Last Update Date | 2020-04-08 |