| 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 |