| NPI | 1700317161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00744200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 012919) |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-08-25 |