| NPI | 1689165821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 0130171) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 007383) |
| Enumeration Date | 2018-05-23 |
| Last Update Date | 2023-08-06 |