| NPI | 1093256679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00748100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4703) |
| Enumeration Date | 2017-03-15 |
| Last Update Date | 2018-07-06 |