| NPI | 1609323518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012485) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012485-1) |
| Enumeration Date | 2016-09-08 |
| Last Update Date | 2023-04-27 |