| NPI | 1962945204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY x012718-1) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00756500) |
| Enumeration Date | 2016-11-18 |
| Last Update Date | 2026-09-21 |