| NPI | 1649341942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00312100) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X0044501) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-07-08 |