| NPI | 1477614279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009936) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 009936) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2020-07-10 |