| NPI | 1417204538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012205-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OH 4300) |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2013-10-29 |