| NPI | 1922086891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00369700) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NY X005872-1) |
| Enumeration Date | 2006-01-02 |
| Last Update Date | 2011-10-04 |