| NPI | 1932289006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT CT379) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY NY3025) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2008-02-13 |