| NPI | 1396785499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00498700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X1101990-1) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2024-08-19 |