| NPI | 1366494221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00279400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC02794) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2015-07-28 |