| NPI | 1205983715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00624900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010584) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2016-10-06 |