| NPI | 1073524120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 006108) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00512800) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2007-10-19 |