| NPI | 1912015249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: NJ 24mz00011200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00305500) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2025-09-11 |