| NPI | 1033131065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00332500) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC003301L) |
| 111N00000X Chiropractor (Licence: FL CH5395) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-03-19 |