| NPI | 1700947306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00165600) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NC 4759) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2017-03-10 |