| NPI | 1912045121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X44531) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005767-1) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2008-11-14 |