| NPI | 1477787232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00684100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IL 038.011378) |
| Enumeration Date | 2009-05-08 |
| Last Update Date | 2020-05-12 |