NPI | 1245431774 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00635600) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0109831) |
Enumeration Date | 2007-05-31 |
Last Update Date | 2015-03-30 |