| NPI | 1295938702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011497) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00662900) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2018-12-03 |