| NPI | 1215458898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NN1001X Chiropractor Nutrition (Licence: NJ 38MC00746700) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: NJ 38MC00746700) |
| 111NS0005X Chiropractor Sports Physician (Licence: NJ 38MC00746700) | |
| Enumeration Date | 2017-07-04 |
| Last Update Date | 2018-11-28 |