| NPI | 1023534518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012986-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00746300) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2017-08-25 |