| NPI | 1316017148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011605) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NH 7771106) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2010-04-07 |