| NPI | 1457492126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006838-1) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X006838-1) |
| Enumeration Date | 2007-02-08 |
| Last Update Date | 2024-07-17 |