| NPI | 1053587501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00664200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70 011267) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2011-07-05 |