| NPI | 1992775464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00155100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MA 421) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-07-08 |