| NPI | 1134545833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00709900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 9145) |
| Enumeration Date | 2014-03-05 |
| Last Update Date | 2022-04-12 |