| NPI | 1720262983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00661600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 7011470) |
| Enumeration Date | 2007-12-24 |
| Last Update Date | 2023-09-13 |