| NPI | 1447690466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 1954) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70 012383) |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2014-10-27 |