| NPI | 1760569594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00579300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH 8802) |
| 111N00000X Chiropractor (Licence: NY x010013) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-10-01 |