| NPI | 1205005477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NX0800X Chiropractor, Orthopedic (Licence: NJ 38MC00713300) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC009921) |
| Enumeration Date | 2008-02-21 |
| Last Update Date | 2022-07-21 |