| NPI | 1164181053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00781500) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: NJ 38MC00781500) |
| Enumeration Date | 2021-12-08 |
| Last Update Date | 2021-12-08 |