| NPI | 1245291020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x003719-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC04210) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2012-01-17 |