| NPI | 1902376536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY 013177) |
| Additional Taxonomies | 111NR0400X (Licence: NY 013177) |
| 111NX0100X Chiropractor, Occupational Health (Licence: NY 013177) | |
| 111N00000X Chiropractor (Licence: NY 013177) | |
| Enumeration Date | 2018-11-27 |
| Last Update Date | 2018-11-27 |