| NPI | 1700800158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010474) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2453) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |