| NPI | 1104948553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY X007822) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00489400) |
| 111NS0005X Chiropractor, Sports Physician (Licence: PA AJ009411) | |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2007-07-08 |