| NPI | 1003986654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN0400X Chiropractor, Neurology (Licence: NJ MC04476) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC04476) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2025-09-11 |