| NPI | 1770663544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009719) |
| Additional Taxonomies | 111NR0400X (Licence: MD 03473) |
| 111NR0400X (Licence: VA 0104556400) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2008-12-12 |