| NPI | 1811926520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00352300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC 03523) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2009-08-20 |