| NPI | 1083891741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011775-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00663500) |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2015-08-12 |