| NPI | 1801080411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X008895-1) |
| Additional Taxonomies | 111NR0400X (Licence: NY XOO8895-1) |
| 111NR0400X (Licence: CA DC 28445) | |
| 111NR0400X (Licence: NJ 38MC00522800) | |
| 111N00000X Chiropractor (Licence: NJ DC28445) | |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2012-01-12 |