| NPI | 1932328150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY X009952-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00577800) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2022-01-13 |