| NPI | 1598860223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00584200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104001992) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-12-16 |