| NPI | 1366442311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 246ZE0600X Specialist/Technologist, Other Electroneurodiagnostic |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 010730) |
| 111N00000X Chiropractor (Licence: NJ 38MC00665200) | |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2011-03-23 |