| NPI | 1972670271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00541800) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NY X009210-0) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2009-03-17 |