| NPI | 1114102662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006248-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 1525) |
| Enumeration Date | 2008-01-03 |
| Last Update Date | 2008-01-03 |