| NPI | 1457726184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x008997-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00666200) |
| Enumeration Date | 2015-12-07 |
| Last Update Date | 2015-12-07 |