| NPI | 1831380864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY XOO3235-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH3899) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2007-08-06 |