| NPI | 1699816538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00622800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x009946) |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2008-06-19 |