| NPI | 1487849980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00723600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: RI DCP00559) |
| 111N00000X Chiropractor (Licence: SC 3653) | |
| Enumeration Date | 2007-09-09 |
| Last Update Date | 2017-09-29 |