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 |