| NPI | 1972519254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: NJ MC005732) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ MC005732) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2019-08-28 |