| NPI | 1235290552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00353100) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NJ MC3531) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2025-08-13 |