| NPI | 1891043733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 70012246) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 10724) |
| Enumeration Date | 2012-08-27 |
| Last Update Date | 2012-10-12 |