| NPI | 1043445752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00697200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011829-1) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2024-06-03 |