| NPI | 1699728717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 3888) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00648000) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-09-23 |