| NPI | 1780690990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X003059-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 009221-1) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-04-07 |