| NPI | 1447661129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00717100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x012518) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2014-05-15 |