| NPI | 1063412252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00294200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 004343-1) |
| 111N00000X Chiropractor (Licence: VI 8) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2007-07-08 |