| NPI | 1972618148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC05944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104555940) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2008-04-16 |