| NPI | 1336388917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00699700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH9677) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2025-12-23 |