| NPI | 1053499525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011611-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00604600) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2014-07-18 |