| NPI | 1891965372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 02102) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 6893) |
| Enumeration Date | 2008-03-11 |
| Last Update Date | 2008-03-11 |