| NPI | 1164972717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00740100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: KY 5490) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2016-12-08 |