| NPI | 1912971136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X3403) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NY X3403) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-03-19 |