| NPI | 1447374574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X2381) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00612100) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2016-07-18 |