| NPI | 1942356464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 011368-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 011368) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2014-06-09 |