| NPI | 1770989725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012584) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 005376) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2023-11-17 |