| NPI | 1043415078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00649600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000674) |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2012-06-06 |