| NPI | 1992864078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010502) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2014-02-10 |