| NPI | 1669472353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00268000) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00268000) |
| 171100000X Acupuncturist (Licence: NJ 25MZ00123800) | |
| 111N00000X Chiropractor (Licence: MA 813) | |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2016-12-14 |