| NPI | 1942494638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006045) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: NY X006045) |
| 111NX0100X Chiropractor Occupational Health (Licence: NY X006045) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2017-12-30 |