| NPI | 1306967310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x005822) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00652300) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2007-07-08 |