| NPI | 1952529877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00355900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X005377) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-12-31 |