| NPI | 1578863577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011893-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00685400) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2016-06-20 |