| NPI | 1487430278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013757) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00800100) |
| Enumeration Date | 2023-09-06 |
| Last Update Date | 2023-09-06 |