| NPI | 1295235638 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00755200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID Chia-1823) |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2020-12-02 |