| NPI | 1124059357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x009236) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC0058300) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2010-07-08 |