| NPI | 1689177750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00751200) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NJ 25MZ00136400) |
| Enumeration Date | 2018-03-14 |
| Last Update Date | 2019-02-12 |