| 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 |