| NPI | 1972256584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38mc00807600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: FL CH13925) |
| Enumeration Date | 2022-02-02 |
| Last Update Date | 2025-02-11 |