| NPI | 1821173014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010784-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x010784) |
| Enumeration Date | 2006-10-26 |
| Last Update Date | 2021-05-05 |