| NPI | 1558904730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: VA 0104557939) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00766000) |
| Enumeration Date | 2019-10-21 |
| Last Update Date | 2026-02-24 |