| NPI | 1366577694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC03258) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CT 000583) |
| 111N00000X Chiropractor (Licence: NY 004830) | |
| 111N00000X Chiropractor (Licence: FL 5462) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2007-07-08 |