| NPI | 1306935796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00599600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NV B01001) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2025-01-09 |