| NPI | 1427075167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 000401) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00244100) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |