| NPI | 1033436290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00688100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY x011858) |
| 111N00000X Chiropractor (Licence: PA DC010334) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2015-12-09 |