| NPI | 1083636708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC002161L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 1898) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2008-01-02 |