| NPI | 1326180704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00586600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0102621) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2011-04-05 |