| NPI | 1790979839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011447) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 11447) |
| Enumeration Date | 2007-08-31 |
| Last Update Date | 2021-06-07 |