| NPI | 1841329752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NN1001X Chiropractor, Nutrition (Licence: NJ CH0001954) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NJ CH0001954) |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2007-07-08 |