| NPI | 1477707792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00665800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011593-1) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2008-11-13 |