| NPI | 1770758583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00673300) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 09784) |
| 111NN0400X Chiropractor, Neurology (Licence: NJ 38MC00673300) | |
| Enumeration Date | 2008-04-23 |
| Last Update Date | 2020-06-08 |