| NPI | 1861371643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: OR 6465) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013718) |
| Enumeration Date | 2025-08-27 |
| Last Update Date | 2025-08-27 |