NPI | 1902376536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY 013177) |
Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (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 |