| NPI | 1710085493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006947-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH-14675) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2025-10-10 |