| NPI | 1992971097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 3458) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 6047) |
| Enumeration Date | 2008-05-08 |
| Last Update Date | 2008-09-03 |