| NPI | 1801180740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225000000X Orthotic Fitter (Licence: NJ C53544) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ mc03636) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2024-02-11 |