| NPI | 1952057283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00789600) |
| Additional Taxonomies | 111NN1001X Chiropractor, Nutrition (Licence: NJ 38MC00789600) |
| Enumeration Date | 2022-02-24 |
| Last Update Date | 2022-02-24 |