| NPI | 1205161460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00678700) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC010152) |
| Enumeration Date | 2009-10-06 |
| Last Update Date | 2011-09-21 |