| NPI | 1538214606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X3567) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00634000) |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2007-07-08 |