| NPI | 1568511863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY X2293) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: FL 3198) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2008-06-30 |