| NPI | 1306146741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009699) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001456) |
| Enumeration Date | 2010-11-02 |
| Last Update Date | 2010-11-02 |