| NPI | 1861854705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009157) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X009157) |
| Enumeration Date | 2016-03-21 |
| Last Update Date | 2016-03-21 |