| NPI | 1821259201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011654) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9578) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2011-08-31 |