| NPI | 1427401413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: IN 08003269A) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00724500) |
| Enumeration Date | 2016-07-14 |
| Last Update Date | 2022-11-14 |