| NPI | 1376612937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X007817-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00653300) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2022-10-24 |