| NPI | 1346438470 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MP99056050) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x007940) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2007-10-15 |