| NPI | 1992863047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00494700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X0083321) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2020-01-17 |