| NPI | 1780911859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: SC 5077) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00678800) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2024-11-03 |