| NPI | 1871662965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00320400) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00320400) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2025-03-10 |