| NPI | 1679723878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X011725) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00675600) |
| Enumeration Date | 2008-09-24 |
| Last Update Date | 2009-07-22 |