| NPI | 1598162448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00801900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012576) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2024-01-11 |