| NPI | 1215334461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00720000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 70012740) |
| 111NR0400X (Licence: NJ 38MC00720000) | |
| Enumeration Date | 2014-12-03 |
| Last Update Date | 2019-07-22 |