| NPI | 1982690749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X005378-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 1251) |
| 111N00000X Chiropractor (Licence: VT 006-0000794) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2007-07-08 |