| NPI | 1720626062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00811300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA 34398) |
| Enumeration Date | 2019-12-17 |
| Last Update Date | 2025-12-11 |