| NPI | 1205982832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NS0005X Chiropractor, Sports Physician (Licence: NJ 38MC00423100) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: PA DC-004734-L) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |