| NPI | 1821184896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0061121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 000860) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2008-07-24 |