| NPI | 1023433935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00730700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 11136) |
| Enumeration Date | 2014-02-28 |
| Last Update Date | 2015-09-21 |