| NPI | 1497804983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00706600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 2358) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2014-10-21 |