| NPI | 1689627358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X0028951) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00221700) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-07-09 |