| NPI | 1982701520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: FL CH9887) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NJ MC005560NJ) |
| 246Z00000X Specialist/Technologist, Other (Licence: FL 832) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2013-10-07 |