| NPI | 1104551449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38Mc00794000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 01253642) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2022-08-09 |