| NPI | 1902198427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00692100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x012010-1) |
| 111NN0400X Chiropractor, Neurology (Licence: NY x012010-1) | |
| 111NN0400X Chiropractor, Neurology (Licence: NJ 38MC00692100) | |
| 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00692100) | |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2011-05-03 |