| NPI | 1023132644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00701200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010144) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2015-03-16 |