| NPI | 1265595896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X001746-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009146) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2013-11-27 |