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 |