| NPI | 1629379979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011882) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1854) |
| Enumeration Date | 2010-11-03 |
| Last Update Date | 2012-10-03 |