| NPI | 1932304045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0115121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011512) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2019-10-16 |