| NPI | 1184738858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00692600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011087) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2011-10-11 |