| NPI | 1912960071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X2717) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NY X2717) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-09-03 |