| NPI | 1093991606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC009895) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00663600) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2008-01-28 |