| NPI | 1982632873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 005754) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005754-1) |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2020-03-20 |