| NPI | 1275606642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 009842) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NY 009842) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY 009842) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY 009842) | |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2007-07-08 |