| NPI | 1558746057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x012520) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00723200) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2018-03-17 |