| NPI | 1578758694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY CO-005598-0B) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00607600) |
| Enumeration Date | 2007-09-11 |
| Last Update Date | 2015-09-29 |