| NPI | 1053071258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00802300) |
| Additional Taxonomies | 111NR0400X (Licence: GA chiro10687) |
| Enumeration Date | 2021-12-29 |
| Last Update Date | 2024-06-01 |