| NPI | 1841262920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CO 5821) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00518000) |
| Enumeration Date | 2006-02-03 |
| Last Update Date | 2017-03-02 |