| NPI | 1962565648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00705700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X007493) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2024-05-19 |