| NPI | 1578780045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008920) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC05976) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2007-07-08 |