| NPI | 1750833174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: NY 012406) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012406) |
| Enumeration Date | 2016-11-02 |
| Last Update Date | 2016-11-02 |