| NPI | 1750320891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: NJ QA00407200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC00374000) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-05-01 |