| NPI | 1104126267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00687000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010321) |
| Enumeration Date | 2010-10-23 |
| Last Update Date | 2023-04-13 |