| NPI | 1457464042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00442600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: DE F1-0000767) |
| 111N00000X Chiropractor (Licence: PA DC010870) | |
| 111N00000X Chiropractor (Licence: NJ MC04426) | |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2022-04-18 |