| NPI | 1710358981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00734800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VA 0104557252) |
| 111N00000X Chiropractor (Licence: PA DC011201) | |
| Enumeration Date | 2015-10-14 |
| Last Update Date | 2026-05-11 |