| NPI | 1952434615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00483900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0080371) |
| 111N00000X Chiropractor (Licence: SC 1988) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |