| NPI | 1265436646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00428800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X4379) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2020-08-03 |