| NPI | 1538104187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NI0900X Chiropractor, Internist (Licence: NY X007419) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 030921) |
| Enumeration Date | 2006-06-18 |
| Last Update Date | 2008-12-03 |