| NPI | 1962572883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X004397-1) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 003463-1) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2011-03-25 |