| NPI | 1982742797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00605700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 8464) |
| 111N00000X Chiropractor (Licence: NY X010248-1) | |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2007-07-08 |