| NPI | 1841504651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC01638) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X1995) |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2010-08-04 |