| NPI | 1609492867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 013382) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38Mc00772000) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2020-07-08 |