| NPI | 1225883325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00804500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 013858) |
| Enumeration Date | 2024-04-22 |
| Last Update Date | 2024-10-13 |