| NPI | 1497971519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC000583800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00583800) |
| 261QP2000X Clinic/Center, Physical Therapy (Licence: NJ 40QA01631800) | |
| Enumeration Date | 2007-04-17 |
| Last Update Date | 2019-09-18 |