| NPI | 1063774693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012187-1) |
| Additional Taxonomies | 111NN1001X Chiropractor Nutrition (Licence: NY X012187-1) |
| 111NS0005X Chiropractor Sports Physician (Licence: NY X012187) | |
| 171100000X Acupuncturist (Licence: NY 004991) | |
| Enumeration Date | 2012-06-11 |
| Last Update Date | 2013-01-31 |