| NPI | 1629100177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X002264-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC00178300) |
| 111N00000X Chiropractor (Licence: FL CH6970) | |
| Enumeration Date | 2007-03-11 |
| Last Update Date | 2007-07-08 |