| NPI | 1811968084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 009398) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001213) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2010-02-22 |