| NPI | 1225087711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor, Radiology (Licence: MA 2821) |
| Additional Taxonomies | 111NR0200X Chiropractor, Radiology (Licence: NY 8662X) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2008-06-25 |