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 |