| NPI | 1386645042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00303200) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA00149300) |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2010-08-20 |