| NPI | 1184769309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X2429-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 1885) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-11-28 |