| NPI | 1326161233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00286800) |
| Additional Taxonomies | 111NI0013X Chiropractor Independent Medical Examiner (Licence: NJ 38MC00286800) |
| 111NN0400X Chiropractor Neurology (Licence: NJ 38MC00286800) | |
| 111NR0400X Chiropractor Rehabilitation (Licence: NJ 38MC00286800) | |
| 111NS0005X Chiropractor Sports Physician (Licence: NJ 38MC00286800) | |
| 111NX0100X Chiropractor Occupational Health (Licence: NJ 38MC00286800) | |
| 111NX0800X Chiropractor Orthopedic (Licence: NJ 38MC00286800) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2010-07-01 |