| NPI | 1487714929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: SC 2560) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009894) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2008-01-03 |