| NPI | 1700899259 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 101484) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00603700) |
| 111NN0400X Chiropractor, Neurology (Licence: NY 010484) | |
| 111NR0400X (Licence: NY 010484) | |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2007-12-31 |