| NPI | 1467518126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00450200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC004502) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-02-01 |