| NPI | 1073882015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012098) |
| Additional Taxonomies | 111NR0400X (Licence: NY X012098) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY X012098) | |
| Enumeration Date | 2011-12-20 |
| Last Update Date | 2013-05-05 |