| NPI | 1194769505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NJ MC02310) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC002310) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2024-11-05 |