| NPI | 1801952411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 817) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY xoo5995-1) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2007-07-08 |