NPI | 1306054788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00188700) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009706-1) |
Enumeration Date | 2007-05-18 |
Last Update Date | 2012-09-27 |