| NPI | 1679028724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00736500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012850) |
| Enumeration Date | 2016-08-18 |
| Last Update Date | 2019-10-11 |