| NPI | 1750458477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00557200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 2250) |
| 111N00000X Chiropractor (Licence: SC 1927) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2007-07-09 |