| NPI | 1770702045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NY 008103) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NY 008103) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2011-09-23 |