| NPI | 1568505865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0108111) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 0195) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-03-29 |