| NPI | 1407248594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00723100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 5049-12) |
| Enumeration Date | 2015-02-26 |
| Last Update Date | 2024-02-15 |