| NPI | 1881852143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00558600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X009207) |
| Enumeration Date | 2008-05-23 |
| Last Update Date | 2023-09-08 |