| NPI | 1649207432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 009689) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 3112) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2008-10-01 |