| NPI | 1093256356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00298800) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NJ 38MC0029880) |
| Enumeration Date | 2017-03-19 |
| Last Update Date | 2017-03-19 |