| NPI | 1437298130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ MC005292) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00529200) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2011-08-09 |