| NPI | 1407979552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: NJ 26NJ00447700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00506900) |
| 111N00000X Chiropractor (Licence: NY 38MC00506900) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2021-07-28 |