| NPI | 1376602904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC02219) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: SC 2649) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2009-09-17 |