| NPI | 1619365467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X013398) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010986) |
| 111N00000X Chiropractor (Licence: NJ 38MC00734300) | |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2021-01-21 |