| NPI | 1922147669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY XO11849) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001708) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2014-08-28 |