| NPI | 1942345020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00336400) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X010312-1) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |