| NPI | 1225039282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00313700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 3137) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2012-08-15 |