| NPI | 1891797411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010033) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC005753) |
| 111N00000X Chiropractor (Licence: FL CH8904) | |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2007-07-08 |