| NPI | 1386703445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009347) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 009347) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2009-11-20 |