| NPI | 1104034297 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006031-1) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NY X006031-1) |
| Enumeration Date | 2007-05-20 |
| Last Update Date | 2007-07-09 |