| NPI | 1093820433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001313) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X-005230-1) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2014-05-20 |