| NPI | 1508186636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NY x2749) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: NY x2749) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NY x2749) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY x2749) | |
| 111NX0800X Chiropractor, Orthopedic (Licence: NY x2749) | |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2010-06-11 |