| NPI | 1427268044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 70012627) |
| Additional Taxonomies | 2083S0010X Preventive Medicine, Sports Medicine (Licence: NY 67 001479) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2015-04-02 |