| NPI | 1962579045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00568000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X98111) |
| 171100000X Acupuncturist (Licence: NJ 25MZ00042300) | |
| 171100000X Acupuncturist (Licence: NY 002988-1) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2007-07-08 |