| NPI | 1891429429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00793800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH14152) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2023-03-03 |