| NPI | 1881769529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X010333) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00601200) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2007-07-09 |