| NPI | 1700992831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 7494) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 1104) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2013-04-19 |