| NPI | 1447456629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00597000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 9354) |
| 111NS0005X Chiropractor, Sports Physician (Licence: FL CH 9354) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2018-10-27 |