| NPI | 1043284151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 0000516) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 6141) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2007-07-08 |