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 |