| NPI | 1124102157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00246000) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00246000) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2007-07-08 |