| NPI | 1225135866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00690500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26923) |
| 111N00000X Chiropractor (Licence: NY X011994) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2019-04-17 |