| NPI | 1871702001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00575200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY 4077) |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2019-07-16 |