| NPI | 1225158942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00195500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0024861) |
| 111N00000X Chiropractor (Licence: CA 22622) | |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2007-07-08 |