| NPI | 1801927520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010162) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3114) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2019-03-25 |