| NPI | 1477755163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC05041) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008533) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2014-01-13 |