| NPI | 1861721375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x011794) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010203) |
| Enumeration Date | 2009-12-11 |
| Last Update Date | 2010-08-31 |