| NPI | 1346450202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NJ 38MC00571900) |
| Additional Taxonomies | 111NR0400X (Licence: NC 38MC00571900) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00571900) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2007-07-08 |