| NPI | 1790855468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00611800) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC006118) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-07-21 |