NPI | 1871760132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NY X011125) |
Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC000659400) |
Enumeration Date | 2008-05-14 |
Last Update Date | 2013-09-25 |