| NPI | 1942556006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC007060000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012197) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2019-10-03 |