| NPI | 1518207257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00703000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012234-1) |
| Enumeration Date | 2013-02-17 |
| Last Update Date | 2013-02-17 |