| NPI | 1144699612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00730200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70 012442) |
| Enumeration Date | 2015-09-15 |
| Last Update Date | 2020-11-30 |