| NPI | 1134392145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0100X Chiropractor, Occupational Health (Licence: NY x0098211) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY x0098211) |
| Enumeration Date | 2008-04-10 |
| Last Update Date | 2008-04-10 |