| NPI | 1528470390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 002158) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00717300) |
| 111N00000X Chiropractor (Licence: NY X012521) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2021-11-19 |