| NPI | 1174676167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC00580900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY CO9080-5B) |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2007-07-08 |