| NPI | 1558458430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00654000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009525) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2023-09-20 |