| NPI | 1215147376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010264) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 051950) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2008-01-12 |