| 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 |