| NPI | 1013016641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 989) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 7031) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2014-08-04 |