| NPI | 1740958776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013616) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 2241) |
| Enumeration Date | 2021-09-03 |
| Last Update Date | 2024-06-26 |