| NPI | 1881479251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00799300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X013740-01) |
| Enumeration Date | 2023-08-25 |
| Last Update Date | 2024-06-25 |