| NPI | 1134104938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011548) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 2822) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2010-10-22 |