| NPI | 1831158534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x010301) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003109) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2014-04-16 |