| NPI | 1679711584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00672100) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: NJ 38MC00672100) |
| Enumeration Date | 2009-01-30 |
| Last Update Date | 2009-01-30 |