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 |