| NPI | 1407835622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 001904) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00522700) |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2025-10-14 |