| NPI | 1346295078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 9371) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY X009371-2) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2013-12-23 |