| NPI | 1083755490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00616700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 001493) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2016-11-09 |