| NPI | 1518950690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: FL CH12398) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC05549) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2023-06-23 |