| NPI | 1134277619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NJ 25MB10577900) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00505000) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2019-05-06 |