| NPI | 1093786915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC005068) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MD 1800) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2017-05-03 |