| NPI | 1972858736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00702600) |
| Additional Taxonomies | 111NR0400X Chiropractor, Rehabilitation (Licence: NJ 38MC00702600) |
| 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00702600) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: NJ 38MC00702600) | |
| 111NR0200X Chiropractor, Radiology (Licence: NJ 38MC00702600) | |
| 111NN0400X Chiropractor, Neurology (Licence: NJ 38MC00702600) | |
| 111NN1001X Chiropractor, Nutrition (Licence: NJ 38MC00702600) | |
| 111NP0017X Chiropractor, Pediatric Chiropractor (Licence: NJ 38MC00702600) | |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2022-07-21 |