| NPI | 1013088533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 906) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 20541) |
| 111N00000X Chiropractor (Licence: NY X06581) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2008-01-24 |