| NPI | 1477988699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00227700) |
| Additional Taxonomies | 111NI0013X Chiropractor, Independent Medical Examiner (Licence: NJ 38MC00227700) |
| 111NN1001X Chiropractor, Nutrition (Licence: NJ 38MC00227700) | |
| 111NR0400X (Licence: NJ 38MC00227700) | |
| Enumeration Date | 2013-09-06 |
| Last Update Date | 2013-09-06 |