| NPI | 1124224381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00634600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X011438) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2021-09-16 |