| NPI | 1669516886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X002340) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001024) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2007-11-08 |