| NPI | 1497805329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NY X009494-1) |
| Additional Taxonomies | 111NR0400X (Licence: NY X009494-1) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY X009494-1) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: NY X009494-1) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: NY X009494-1) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2007-07-08 |