| NPI | 1730131558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ mc05592) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NJ MC005592) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-08-12 |