| NPI | 1699288696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00749200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: IN 08003109A) |
| Enumeration Date | 2017-11-13 |
| Last Update Date | 2021-10-20 |