| NPI | 1942216700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MD00556400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0093051) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NY 4119) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2013-01-07 |