| NPI | 1447261060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY C02664) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00432600) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2023-04-14 |