| NPI | 1790845105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: NJ 28MC00520400) |
| Additional Taxonomies | 111NS0005X Chiropractor Sports Physician (Licence: NJ 38MC00520400) |
| 111N00000X Chiropractor (Licence: NJ 38MC00520400) | |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2007-07-08 |