| NPI | 1700864477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X000772-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0007721) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2009-01-07 |