| NPI | 1619282688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00682300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70011771) |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2010-09-10 |