| NPI | 1417019506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 006238) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: NY 340010) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2015-12-02 |