| NPI | 1740207174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00662600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14303) |
| 111N00000X Chiropractor (Licence: NY X010776-1) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2025-04-09 |