NPI | 1619327533 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY 012852) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012852) |
111NR0400X Chiropractor, Rehabilitation (Licence: NY 012852) | |
Enumeration Date | 2016-06-21 |
Last Update Date | 2016-06-21 |