| NPI | 1386760908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000876) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 3797) |
| 111N00000X Chiropractor (Licence: NJ X005823) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2016-11-14 |