| NPI | 1679757009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MCO3510) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009592-1) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2010-08-12 |