| NPI | 1366755365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001852) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00684600) |
| 111N00000X Chiropractor (Licence: NY X011894) | |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2012-01-31 |