| NPI | 1215160957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: PA DC007969L) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38MC00614500) |
| Enumeration Date | 2009-08-28 |
| Last Update Date | 2019-05-10 |