| NPI | 1568472454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: DE F10000574) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x00004739-1) |
| 171100000X Acupuncturist (Licence: NY 000634-1) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2010-07-20 |