| NPI | 1740683663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X012779-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00718200) |
| Enumeration Date | 2014-10-06 |
| Last Update Date | 2020-04-21 |