| NPI | 1619903234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 4435) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00443500) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2024-12-18 |