| NPI | 1780971507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL 3680) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 2159) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-06-30 |