| NPI | 1285701888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NS0005X Chiropractor Sports Physician (Licence: NJ MC04697) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH7049) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2016-11-03 |