| NPI | 1124365432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 70012249) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00694400) |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2013-01-08 |