| NPI | 1831396951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X-010428) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010428) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2017-01-17 |