| NPI | 1407018930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 011513) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2023-09-07 |