| NPI | 1174653794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X002912) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 2166) |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2007-11-20 |