| NPI | 1780757666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010423-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00603300) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2009-03-26 |