| NPI | 1144689324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MA 3527) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00734100) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2017-03-06 |