| NPI | 1619973898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC02937) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X003329) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2008-10-22 |