| NPI | 1063507903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0048051) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 4906) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-10-22 |