| NPI | 1942764246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00775400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: VT 006.0134131) |
| Enumeration Date | 2019-01-31 |
| Last Update Date | 2020-10-13 |