| NPI | 1578629093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NY X004425-1) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: FL CH5057) |
| Enumeration Date | 2006-12-29 |
| Last Update Date | 2007-07-08 |