| NPI | 1255426995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: NJ 38MC00425100) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC004927L) |
| 111N00000X Chiropractor (Licence: NY 70006923) | |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2009-07-06 |