| NPI | 1700842747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00482100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5519) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2008-03-06 |