| NPI | 1407079791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x008941) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NY x008941) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY x008941) | |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2015-04-21 |