| NPI | 1023669314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NC 5189) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00759800) |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2023-06-18 |