| NPI | 1659356087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X001907) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: OK 2062) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2007-07-25 |