| NPI | 1740678218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00737100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MN 6032) |
| Enumeration Date | 2015-01-06 |
| Last Update Date | 2019-06-24 |