| NPI | 1114928678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NY 005746) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00361400) |
| 111N00000X Chiropractor (Licence: PA DC-003921-L) | |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2012-10-10 |