| NPI | 1114688090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013552) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00790900) |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2023-03-09 |