| 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 |