| NPI | 1871679225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X006709) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00492000) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2007-07-08 |