| NPI | 1912712704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00811800) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00811800) |
| 111NR0400X Chiropractor, Rehabilitation (Licence: NJ 38MC00811800) | |
| Enumeration Date | 2025-02-10 |
| Last Update Date | 2025-04-16 |