| NPI | 1104715606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NJ 38MC00806500) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: FL 15440) |
| Enumeration Date | 2025-06-30 |
| Last Update Date | 2025-06-30 |