| NPI | 1912149766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00685600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC31216) |
| Enumeration Date | 2009-03-25 |
| Last Update Date | 2010-10-20 |