| NPI | 1972502524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC005170) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X008777-1) |
| Enumeration Date | 2005-07-16 |
| Last Update Date | 2008-09-05 |