| NPI | 1104973973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: MT 1110) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00304700) |
| 171100000X Acupuncturist (Licence: NJ 25MZ00038600) | |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2012-09-18 |