| NPI | 1922211622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00629200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH2444) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-07-08 |