| NPI | 1174654602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011675-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR007475) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2010-03-02 |