| NPI | 1205305372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00767000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH60914871) |
| Enumeration Date | 2018-11-19 |
| Last Update Date | 2023-08-10 |