| NPI | 1609108596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012040-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010377) |
| Enumeration Date | 2010-02-03 |
| Last Update Date | 2012-12-20 |