| NPI | 1477596393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x010801) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY XO10801-1) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2025-07-12 |