| NPI | 1184903593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00695400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MO 2011026323) |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2011-10-14 |