| NPI | 1558724062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012810-1) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: OR 5866) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2018-04-11 |