| NPI | 1053462929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00539200) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC007418L) |
| 111N00000X Chiropractor (Licence: DE F1 0000467) | |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2011-06-01 |