| NPI | 1497999817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: AZ 9176) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00802000) |
| Enumeration Date | 2009-04-29 |
| Last Update Date | 2026-05-07 |