| NPI | 1730489907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009720) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NY X009720) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY X009720) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2019-05-21 |