| NPI | 1447203237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00643000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY xo11114-1) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-12-11 |