| NPI | 1467606376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011601-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP603) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2014-05-12 |