| NPI | 1639268865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0100861) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: NY X-010086-1) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2008-11-24 |