| NPI | 1356642102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL ch12488) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00693600) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2020-06-16 |