| NPI | 1124776752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00794100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: GA CHIR010578) |
| Enumeration Date | 2022-03-14 |
| Last Update Date | 2024-03-26 |