| NPI | 1942309646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x3464) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL 4280) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2010-12-15 |