| NPI | 1578723227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 012419) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 3218) |
| Enumeration Date | 2008-06-16 |
| Last Update Date | 2016-04-25 |