| NPI | 1699755017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009595) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 002041) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2007-10-26 |