| NPI | 1982766333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X005371-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 005394) |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2007-07-08 |