| NPI | 1912015249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00305500) |
| Additional Taxonomies | 208VP0000X Pain Medicine, Pain Medicine (Licence: NJ 24mz00011200) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2007-07-08 |