| NPI | 1376861534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00691800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011847) |
| Enumeration Date | 2010-05-12 |
| Last Update Date | 2013-08-27 |