| NPI | 1568739019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 70-010005) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: NY 70-010005) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY 70-010005) | |
| Enumeration Date | 2011-11-29 |
| Last Update Date | 2023-03-15 |