| NPI | 1598843120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x005763-01) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005763-2) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2025-09-02 |