| NPI | 1992984090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011569-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 004293-1) |
| Enumeration Date | 2007-10-25 |
| Last Update Date | 2023-05-23 |