| NPI | 1710271200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 007900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001723) |
| Enumeration Date | 2011-06-02 |
| Last Update Date | 2011-06-02 |