| NPI | 1629158779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 009582) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00646700) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2016-03-17 |