| NPI | 1700959368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00625500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X010859) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2022-07-15 |