| NPI | 1932714805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: CT 2176) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00156700) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2022-05-09 |