| NPI | 1952423899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor Radiology (Licence: NJ NJ-38MC00208100) |
| Additional Taxonomies | 111NR0400X Chiropractor Rehabilitation (Licence: NJ NJ-38MC00208100) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2007-07-08 |