| NPI | 1487681250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation (Licence: NJ 38MC00181400) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00181400) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00181400) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2011-09-24 |